Economic Impact of Third-Wave Cognitive Behavioral Therapies: A Systematic Review and Quality Assessment of Economic Evaluations in Randomized Controlled Trials

The term third-wave cognitive behavioral therapy (CBT) encompasses new forms of CBT that both extend and innovate within CBT. Most third-wave therapies have been subject to randomized controlled trials (RCTs) focused on clinical effectiveness; however, the number and quality of economic evaluations in these RCTs has been unknown and may be few. Evidence about efficiency of these therapies may help support decisions on efficient allocation of resources in health policies. The main aim of this study was to systematically review the economic impact of third-wave therapies in the treatment of patients with physical or mental conditions. We conducted a systematic literature search in PubMed, PsycINFO, EMBASE, and CINALH to identify economic evaluations of third-wave therapies. Quality and Risk of Bias (RoB) assessment of economic evaluations was also made using the Drummond 35-item checklist and the Cochrane Collaboration’s tool for assessing risk of bias, respectively. Eleven RCTs were included in this systematic review. Mindfulness-Based Cognitive Therapy (MBCT), Mindfulness-Based Stress Reduction (MBSR), Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), and extended Behaviour Activation (eBA) showed acceptable cost-effectiveness and cost-utility ratios. No study employed a time horizon of more than 3 years. Quality and RoB assessments highlight some limitations that temper the findings. There is some evidence that MBCT, MBSR, ACT, DBT, and eBA are efficient from a societal or a third-party payer perspective. No economic analysis was found for many third-wave therapies. Therefore, more economic evaluations with high methodological quality are needed.     

Power Evangelism in a Protestant Context? Reflections after a Workshop in Samosir/Indonesia

This article discusses how the neo‐Pentecostal concept of power evangelism, read from a liberation perspective, might be useful to contextualize evangelism in the Toba Batak region of Samosir. In a situation where evangelistic preaching follows an evangelical forensic paradigm but Christians turn to traditional religious rituals for blessing, healing, and protection, a new approach is needed. Preaching and liturgies informed by a power paradigm might resolve the problem of syncretism, but important theological questions need to be clarified.     

On the role of stimulus preference assessment in the evaluation of contingent access to stimuli associated with stereotypy during behavioral acquisition

Previous authors have reported successful behavioral acquisition in children diagnosed with autism using contingent access to stereotypic responding as reinforcement. Other studies have demonstrated robust reinforcement effects when consequences were selected using stimulus preference assessments. We conducted two stimulus preference assessments with a six-year-old female diagnosed with autism. Her acquisition of a non-vocal imitation response was then evaluated during two reinforcement conditions: contingent access to (i) a stimulus associated with stereotypic object manipulation and (ii) a stimulus unassociated with such stereotypy. Both stimuli were identified from the stimulus preference assessments. Nearly identical response patterns were observed in both conditions; correct responses to verbal prompts greatly increased while correct responses to gestural and physical prompts decreased to near-zero levels. These preliminary findings are discussed in the context of improving stimulus selection in this area. © 1998 John Wiley & Sons, Ltd.     

Limited information estimation and testing of Thurstonian models for paired comparison data under multiple judgment sampling

We relate Thurstonian models for paired comparisons data to Thurstonian models for ranking data, which assign zero probabilities to all intransitive patterns. We also propose an intermediate model for paired comparisons data that assigns nonzero probabilities to all transitive patterns and to some but not all intransitive patterns.There is a close correspondence between the multidimensional normal ogive model employed in educational testing and Thurstone's model for paired comparisons data under multiple judgment sampling with minimal identification restrictions. Alike the normal ogive model, Thurstonian models have two formulations, a factor analytic and an IRT formulation. We use the factor analytic formulation to estimate this model from the first and second order marginals of the contingency table using estimators proposed by Muthén. We also propose a statistic to assess the fit of these models to the first and second order marginals of the contingency table. This is important, as a model may reproduce well the estimated thresholds and tetrachoric correlations, yet fail to reproduce the marginals of the contingency table if the assumption of multivariate normality is incorrect.A simulation study is performed to investigate the performance of three alternative limited information estimators which differ in the procedure used in their final stage: unweighted least squares (ULS), diagonally weighted least squares (DWLS), and full weighted least squares (WLS). Both the ULS and DWLS show a good performance with medium size problems and small samples, with a slight better performance of the ULS estimator.This paper is based on the author's doctoral dissertation; Ulf Böckenholt, advisor. The final stages of this research took place while the author was at the Department of Statistics and Econometrics, Universidad Carlos III de Madrid. The author is indebted to Adolfo Hernández for stimulating discussions that helped improve this paper, and to Ulf Böckenholt and the Associate Editor for a number of helpfulsuggestions to a previous draft.     

A scaled difference chi-square test statistic for moment structure analysis

A family of scaling corrections aimed to improve the chi-square approximation of goodness-of-fit test statistics in small samples, large models, and nonnormal data was proposed in Satorra and Bentler (1994). For structural equations models, Satorra-Bentler's (SB) scaling corrections are available in standard computer software. Often, however, the interest is not on the overall fit of a model, but on a test of the restrictions that a null model sayM ₀ implies on a less restricted oneM ₁. IfT ₀ andT ₁ denote the goodness-of-fit test statistics associated toM ₀ andM ₁, respectively, then typically the differenceT _d =T ₀−T ₁ is used as a chi-square test statistic with degrees of freedom equal to the difference on the number of independent parameters estimated under the modelsM ₀ andM ₁. As in the case of the goodness-of-fit test, it is of interest to scale the statisticT _d in order to improve its chi-square approximation in realistic, that is, nonasymptotic and nonormal, applications. In a recent paper, Satorra (2000) shows that the difference between two SB scaled test statistics for overall model fit does not yield the correct SB scaled difference test statistic. Satorra developed an expression that permits scaling the difference test statistic, but his formula has some practical limitations, since it requires heavy computations that are not available in standard computer software. The purpose of the present paper is to provide an easy way to compute the scaled difference chi-square statistic from the scaled goodness-of-fit test statistics of modelsM ₀ andM ₁. A Monte Carlo study is provided to illustrate the performance of the competing statistics. This research was supported by the Spanish grants PB96-0300 and BEC2000-0983, and USPHS grants DA00017 and DA01070.     

Mapping Residents' Perceptions of Neighborhood Boundaries: A Methodological Note

Neighborhood influences on children and youth are the subjects of increasing numbers of studies, but there is concern that these investigations may be biased, because they typically rely on census-based units as proxies for neighborhoods. This pilot study tested several methods of defining neighborhood units based on maps drawn by residents, and compared the results with census definitions of neighborhoods. When residents' maps were used to create neighborhood boundary definitions, the resulting units covered different space and produced different social indicator values than did census-defined units. Residents' agreement about their neighborhoods' boundaries differed among the neighborhoods studied. This pilot study suggests that discrepancies between researcher and resident-defined neighborhoods are a possible source of bias in studies of neighborhood effects.     

Reasons Why Rational Emotive Behavior Therapy Is Relatively Neglected in the Professional and Scientific Literature

Although rational emotive behavior therapy (REBT) has been the pioneering cognitive behavior therapy (CBT) of the twentieth century, and although its main methods are very popular among practicing clinicians as well as members of the public, it has been relatively neglected in the professional and scientific literature. Reasons for this neglect are discussed and some steps are suggested to make REBT more effective and more scientifically accepted.     

Functional analysis of hair manipulation: a replication and extension

In a multi‐phase investigation, we assessed the problematic hair manipulation of a four‐year‐old male diagnosed with autism. In phase 1, a functional analysis of hair manipulation resulted in high levels of responding during a no‐interaction condition, while near‐zero levels were observed in other conditions. In phase 2, hair manipulation was reduced to near‐zero levels during a condition in which Billy wore gloves on his hands to attenuate digital‐tactile stimulation. In phase 3, a stimulus preference assessment indicated that object manipulation competed with hair manipulation, and that wearing gloves did not alter the amount of time that Billy manipulated preferred objects. The results are discussed in the context of interventions that achieve their effects via reinforcer substitutability or competition. Copyright © 2000 John Wiley & Sons, Ltd.